Using bar-code technology and medication observation methodology for safer medication administration

Paoletti, Richard D.; Suess, Tina M.; Lesko, Michael; Feroli, Alfred A.; Kennel, James A.; Mahler, Joye M.; Sauders, Timothy

doi:10.2146/ajhp060140

Cited by 141 publications

(124 citation statements)

References 7 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…There are also many medication errors that go undetected [7]. Bar-code technology to assist medication has been repeatedly shown to reduce administration errors by about 50% [3,9,10] although there is conflicting evidence in the intensive care setting [10,11]. The American Society of Health-System Pharmacists encourages the use of bar code medical administration technology and has called for all manufacturers to place machine-readable coding of the National Drug Code (NDC), lot number and expiration date on all drug packaging [12].…”

Section: Discussionmentioning

confidence: 99%

“…There are also many medication errors that go undetected [7]. Bar-code technology to assist medication has been repeatedly shown to reduce administration errors by about 50% [3,9,10] Our experience with the combination of pharmacy bar coding and positive patient identification (PPID) at the point of drug administration generated a post-implementation total rate of 38 error alerts per million doses administered, which was an 90% increase over the baseline, preintervention rate. However, when separating these medication administration events into those actually reaching a patient versus "near-misses", we found a decrease in the former, and a statistically significant increase in the latter.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Medication Safety Improves after Implementation of Positive Patient Identification

Higgins¹,

Heelon²,

Siano³

et al. 2010

Appl Clin Inform

View full text Add to dashboard Cite

SummaryObjective: To report the incidence and severity of medication safety events before and after initiation of barcode scanning for positive patient identification (PPID) in a large teaching hospital. Methods: Retrospective analysis of data from an existing safety reporting system with anonymous and non-punitive self-reporting. Medication safety events were categorized as "near-miss" (unsafe conditions or caught before reaching the patient) or reaching the patient, with requisite additional monitoring or treatment. Baseline and post-PPID implementation data on events per 1,000,000 drug administrations were compared by chi-square with p<0.05 considered significant. Results: An average of 510,541 doses were dispensed each month in 2008. Total self-reported medication errors initially increased from 20 per million doses dispensed pre-barcoding (first quarter 2008) to 38 per million doses dispensed immediately post-intervention (last quarter 2008), but errors reaching the patient decreased from 3.26 per million to 0.8 per million despite the increase in "nearmisses". A number of process issues were identified and improved, including additional training and equipment, instituting ParX scanning when filling Pyxis machines, and lobbying for a manufacturing change in how bar codes were printed on bags of intravenous solutions to reduce scanning failures. Conclusion: Introduction of barcoding of medications and patient wristbands reduced serious medication dispensing errors reaching the patient, but temporarily increased the number of "near-miss" situations reported. Overall patient safety improved with the barcoding and positive patient identification initiative. These results have been sustained during the 18 months following full implementation. ObjectivesOur objective was to document the reduction in medication errors reaching patients after introduction of bar code scanning and positive patient identification in a large teaching hospital already using computerized provider order entry. Introduction of bar code scanning was associated with an unexpected increase in reported errors, so we further investigated the source of these error reports. We also report on the problems encountered and solutions deployed in implementing this practice change. MethodsThis study was conducted at Baystate Medical Center, a 655-bed general, acute care tertiary care teaching hospital. This study complies with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research. As this study utilized de-identified data collected for quality improvement, it was not considered human subjects research and thus did not require Institutional Review Board approval. Data analyzed for this study were collected routinely for clinical care and quality improvement, and beyond introduction of bar-code scanning, clinical practice was not affected in any way by the study. Computerized Provider Order Entry (CPOE) was first initiated at Baystate in 1995 and transitioned from a legacy TDS Hospital Information System to Ce...

show abstract

Section: Discussionmentioning

confidence: 99%

“…There are also many medication errors that go undetected [7]. Bar-code technology to assist medication has been repeatedly shown to reduce administration errors by about 50% [3,9,10] Our experience with the combination of pharmacy bar coding and positive patient identification (PPID) at the point of drug administration generated a post-implementation total rate of 38 error alerts per million doses administered, which was an 90% increase over the baseline, preintervention rate. However, when separating these medication administration events into those actually reaching a patient versus "near-misses", we found a decrease in the former, and a statistically significant increase in the latter.…”

mentioning

confidence: 99%

Medication Safety Improves after Implementation of Positive Patient Identification

Higgins¹,

Heelon²,

Siano³

et al. 2010

Appl Clin Inform

View full text Add to dashboard Cite

show abstract

“…[14][15][16][17][18] Similarly, use of BC product verification during selection, preparation, and dispensing of electronically ordered pharmaceuticals has resulted in reduced rates of dispensing errors. [19][20][21][22][23][24][25][26] Accordingly, implementation and use of BC technology in dispensing procedures has received enthusiastic professional endorsement.…”

Section: Electronic Inventory Systems and Barcode Technologymentioning

confidence: 99%

Electronic Inventory Systems and Barcode Technology: Impact on Pharmacy Technical Accuracy and Error Liability

Oldland¹,

Golightly²,

May³

et al. 2015

Hospital Pharmacy

View full text Add to dashboard Cite

Purpose: To measure the effects associated with sequential implementation of electronic medication storage and inventory systems and product verification devices on pharmacy technical accuracy and rates of potential medication dispensing errors in an academic medical center. Methods: During four 28-day periods of observation, pharmacists recorded all technical errors identified at the final visual check of pharmaceuticals prior to dispensing. Technical filling errors involving deviations from order-specific selection of product, dosage form, strength, or quantity were documented when dispensing medications using (a) a conventional unit dose (UD) drug distribution system, (b) an electronic storage and inventory system utilizing automated dispensing cabinets (ADCs) within the pharmacy, (c) ADCs combined with barcode (BC) verification, and (d) ADCs and BC verification utilized with changes in product labeling and individualized personnel training in systems application. Results: Using a conventional UD system, the overall incidence of technical error was 0.157% (24/15,271). Following implementation of ADCs, the comparative overall incidence of technical error was 0.135% (10/7,379; P = .841). Following implementation of BC scanning, the comparative overall incidence of technical error was 0.137% (27/19,708; P = .729). Subsequent changes in product labeling and intensified staff training in the use of BC systems was associated with a decrease in the rate of technical error to 0.050% (13/26,200; P = .002). Conclusions: Pharmacy ADCs and BC systems provide complementary effects that improve technical accuracy and reduce the incidence of potential medication dispensing errors if this technology is used with comprehensive personnel training.

show abstract

“…26 Unfortunately, double-checking all anesthesia-related drugs in the busy complex work environment of the operating room is generally impractical and distracting and could lead to error. Nevertheless, bar-coding, which has been shown to reduce preventable medication errors by 50% in other acute and critical care environments, may prove helpful in the operating room.…”

Section: Bar-coding (Automated Identification)mentioning

confidence: 99%

Review article: Improving drug safety for patients undergoing anesthesia and surgery

Orser

Hyland²,

David³

et al. 2012

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose This article presents a summary of recent advances, including tools and interventions, that are designed to improve drug safety for patients in critical care settings, particularly those undergoing anesthesia and surgery. Principal findings Medication error remains a leading cause of adverse events among patients undergoing anesthesia. Misidentification of ampoules, vials, and syringes is a common source of error. Systems are now being engineered to reduce the likelihood of medication misidentification through approaches such as revision of standards for labelling of drug ampoules and vials and the development of bar code systems that allow ''double checking'' or drug verification in the operating room. Also, efforts are being made to improve medication reconciliation, a process for accurately communicating a patient's medication information during transitions from one healthcare setting to another. Finally, the opportunity exists for anesthesiologists to increase awareness about the rising problem of opioid addiction in patients for whom typical doses are initially prescribed for appropriate indications such as postoperative pain. Conclusions There is a need to improve drug delivery systems in complex critical care environments, particularly the operating room. Anesthesiologists must continue to play a leading role in promoting drug safety in these environments.

show abstract

Using bar-code technology and medication observation methodology for safer medication administration

Cited by 141 publications

References 7 publications

Medication Safety Improves after Implementation of Positive Patient Identification

Medication Safety Improves after Implementation of Positive Patient Identification

Electronic Inventory Systems and Barcode Technology: Impact on Pharmacy Technical Accuracy and Error Liability

Review article: Improving drug safety for patients undergoing anesthesia and surgery

Contact Info

Product

Resources

About